Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Churg-Strauss syndrome
- Radiologic Findings
- Initial Chest radiograph shows multifocal patchy consolidation on both lungs.
On chest CT, multifocal patchy consolidations with GGO are scattered in both lungs. Small centrilobular nodules with tree-in-bud patterns and bronchial wall thickening are also seen. Multiple mediastinal LN enlargements are also seen.
On PNS water’s view radiograph, there is irregular mucoperiosteal thickening in both maxillary sinuses, suggesting chronic maxillary sinusitis. Mild GB wall thickening and pericholecystic fluid collection is noted on MRCP.
Chest radiographs had shown wax and wane patterns of multifocal consolidation and nodular opacities in both lungs in proportion to serum eosinophil count.
Surgical specimens of right middle lobe, mediastinal LN, and gallbladder show necrotizing vasculitis with eosinophils, consistent with Churg-Strauss syndrome.
- Brief Review
- Churg-Strauss syndrome, which is known as eosinophilic granulomatosis with polyangiitis and allergic granulomatous angiitis, is a highly variable illness. Some people have only mild symptoms, whereas others experience severe complications. Almost all patients have asthma and eosinophilia but someone also have extrapulmonary signs and symptoms.
There are no specific tests to confirm Churg-Strauss syndrome. Thus the American College of Rheumatology has established criteria for identifying Churg-Struass syndrome. The following features are consistent with a diagnosis of CSS.
- asthma
- eosinophilia of 10% white blood cell count
- migratory or transient pulmonary opacities on chest radiographs
- mononeuropathy or polyneuropathy
- paranasal sius abnormalities
- extravascular eosinophils on biopsy
Radiologic manifestations of CSS are nonspecific but may show transient, patchy, and nonsegmental consolidation or small and large nodular opacities. Ground-glass opacities and consolidation seen on high-resolution CT reflect the presence of eosinophilic pneumonia, vasculitis, and pulmonary alveolar hemorrhage. Centrilobular nodules and bronchial wall thickening also can be seen but less common features.
Treatment for Churg–Strauss syndrome includes glucocorticoids (such as prednisolone) and other immunosuppressive drugs. CSS has no cure but these treatment can usually help control symptoms.
- Please refer to
Case 262, Case 523, Case 595, -
KSTR Imaging Conference 2011 Summer Case 2
,
KSTR Imaging Conference 2008 Summer Case 8,
- References
- - Kim, Yoon Kyung, et al. "Pulmonary involvement in Churg-Strauss syndrome: an analysis of CT, clinical, and pathologic findings." European radiology 17.12 (2007): 3157-3165.
- Greco A, Rizzo MI, De Virgilio A, Gallo A, Fusconi M, Ruoppolo G, Altissimi G, De Vincentiis M. Churg-Strauss syndrome. Autoimmunity Reviews. 2014 Dec 11; . Epub 2014 Dec 11.
- Silva CI, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A. Churg-Strauss syndrome: high resolution CT and pathologic findings. Journal of Thorac Imaging. 2005 May; 20(2):74-80.
- Jeong, Yeon Joo, et al. "Eosinophilic Lung Diseases: A Clinical, Radiologic, and Pathologic Overview 1." Radiographics 27.3 (2007): 617-637.
- Keywords
- Lung, Multiple organ, Vasculitis,